Neurologist care lowers risk for PD-related hospitalizations

Regular care by a neurologist lowers the risk for hospitalization for Parkinson's disease (PD)-related complications, US research shows.

Overall, neurologist care was associated with a significant 29% lower risk for hospitalizations for initial and repeat psychosis, a significant 26% lower risk for urinary tract infection hospitalization, and a significant 44% lower risk for hospital admission for traumatic injury.

Should the results be confirmed with longer-term follow up, "regular neurologist care may prove to be an important disease-modifying intervention for patients with PD," say researcher Allison Willis (Washington University School of Medicine, St Louis, Missouri) and colleagues.

Published in Neurology, the retrospective cohort study included 24,929 Medicare beneficiaries diagnosed with PD in 2002 and still living in 2006. Of these, 13,489 individuals were under the care of a neurologist. During the 48-month observation period, 21% of patients with PD had at least one hospitalization for a PD-related illness.

The reduced risk for hospitalizations associated with neurologist care was specific for PD-related comorbidities, according to the researchers. There was no increased risk for hospitalizations for diabetes, hypertension, gastrointestinal obstruction, congestive heart failure, or angina.

In total, there were 1433 repeat hospitalizations for PD-related illnesses. Individuals with PD under the care of a neurologist were 59% less likely to require more than one hospitalization for psychosis, relative to those who did not see a neurologist, and 50% less likely to have more than one hospitalization for urinary tract infections.

Patients with no outpatient neurologist PD visits during the observation period spent an average of 27.5 days in a skilled-nursing facility and 3.2 days in hospital. By contrast, those with five or more outpatient visits to the neurologist spent 15.2 days in the skilled-nursing facility and 2.7 days in hospital.

Willis et al explain that neurologists are likely have a greater knowledge than other physicians of the autonomic dysfunction prevalent in PD, particularly dysfunction involving the bladder.

In addition, they have a better understanding of iatrogenic psychosis caused by treatment, which can warrant heightened screening to limit some of the adverse complications.

By contrast, there was no reduced risk for depression among the PD patients seeing the neurologist, likely because primary-care physicians frequently care for patients with depression, according to the researchers.

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